Understanding Health and Its Determinants

"Health care is an important determinant of health. Lifestyles are important determinants of health. But... it is factors in the social environment that determine access to health services and influence lifestyle choices in the first place." WHO Director-General 

Many factors combine together to affect the health of individuals and communities. Whether a person is healthy or unhealthy is determined by his/her circumstances and environment. To a large extent, factors such as where we live, the state of our environment, genetics, our income and education level, and our relationships with friends and family all have considerable impacts on health, whereas the more commonly considered factors such as access and use of health care services often have less of an impact.

determinants of health

Determinants of Health

The range of personal, social, economic and environmental factors that influence health status are known as determinants of health.
These can be classified as:

  1. the social and economic environment,
  2. the physical environment,
  3. the person’s individual characteristics and behaviours.

There are many commonly accepted determinants of health but there is no single definition.  The Office of Disease Prevention and Health Promotion (ODPHP) has broadly categorised the determinants of health and these have been summarised below:


Policies at the local, state and federal level affect individual and population health. Increasing taxes on tobacco sales, for example, can improve population health by reducing the number of people using tobacco products.

Social Factors

Social and physical determinants of health reflect the conditions of the environment in which people are born, live, learn, play, work and age. Also known as social determinants of health, they impact a wide range of health, functioning and quality-of-life outcomes. They represent economic and political systems, physical and social environments, as well as health service access.

Examples include:

  • Availability of resources to meet daily needs, such as educational and job opportunities, living wages or healthful foods
  • Social norms and attitudes such as discrimination
  • Exposure to crime, violence and social disorder
  • Social support and social interactions
  • Socioeconomic conditions such as concentrated poverty
  • Quality schools
  • Transportation options
  • Urbanisation and the built environment such as buildings or transportation
  • Worksites, schools and recreational settings

Health Services

Both access to health services and the quality of health services can impact health.  Barriers to accessing health services include lack of availability, high cost, lack of insurance coverage and limited language access.  These barriers to accessing health services lead to unmet health needs, delays in receiving appropriate care, inability to get preventive services as well as hospitalizations that could have been prevented.

Individual Behaviour

Individual behaviors such as diet, physical activity, alcohol, tobacco and other drug use also play a role in health outcomes.

Biology and Genetics

Some biological and genetic factors affect specific populations more than others.  Examples of biological and genetic determinants of health include age, sex, inherited conditions and genetic make-up.

Improving Health World Wide

WHO have identified three "common interventions" for improving health conditions world wide:

1. Education

A large number of studies have demonstrated a strong link between better education and better health, and education has been shown to be a reliable predictor of lower mortality rates. The probability of being in good or very good health is higher for people with university or post-secondary education.

2. Social Protection

Countries with some sort of social protection (i.e. a safety net or social security system) show improved health and economic outcomes in circumstances where people become unable to earn a living.

3. Urban Development

The physical environment where communities live has a great impact on the health of the residents. Factors which have a negative impact on health include overcrowding, damp living conditions and crime (in particular fear of crime). The WHO concludes that health outcomes "are largely determined by the accessibility to adequate housing and to healthy and safe urban environments and by transport conditions".

Relevance to Physiotherapy

In our contact time with our patients, we spend a lot of time understanding their health and social status. In other words, we explore the determinants that might be affecting their health and in particular ones that we can influence. The model we use to analyse and understand these determinants of health is the biopsychosocial model of health care.

It is essential that health care workers dedicated to improving health increase their effectiveness by addressing the “upstream” causes of health in the community and by engaging in ways to change the broad policies, systems and environments that shape the social and economic conditions that, in turn, so strongly influence health.  Swain et al describe opportunities for the health-care professional to address social determinants of health. They suggest that to be most effective at improving the health of families and communities and to ensure the greatest impact for the investment of resources, health professionals need to expand their repertoire of skills and activities both with their individual patients and in the policy arena.

Dr Rohit Bhaskar, Physio
Dr Rohit Bhaskar, Physio Dr. Rohit Bhaskar, Physio is Founder of Bhaskar Health and Physiotherapy and is also a consulting physiotherapist. He completed his Graduation in Physiotherapy from Uttar Pradesh University of Medical Sciences. His clinical interests are in Chest Physiotherapy, stroke rehab, parkinson’s and head injury rehab. Bhaskar Health is dedicated to readers, doctors, physiotherapists, nurses, paramedics, pharmacists and other healthcare professionals. Bhaskar Health audience is the reason I feel so passionate about this project, so thanks for reading and sharing Bhaskar Health.

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